Elisa Done1,2, Leonardo Gucciardo1,2, Tim Van Mieghem1,2, Koen Devriendt3, Karel Allegaert2,4, Paul Brady4, Roland Devlieger1,2, Luc De Catte1,2, Liesbeth Lewi1,2, Jan Deprest1,2,5. 1. Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium. 2. Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven, Leuven, Belgium. 3. Centre for Medical Genetics, University Hospitals Leuven, Leuven, Belgium. 4. Department of Neonatology, University Hospitals Leuven, Leuven, Belgium. 5. UCL Institute for Women's Health, University College London, London, UK.
Abstract
OBJECTIVE: Fetoscopic endoluminal tracheal occlusion (FETO) may improve outcome of severe isolated congenital diaphragmatic hernia (iCDH). We aimed to identify any discrepancy between initial assessment at the referring hospital and the evaluation at the fetal surgery center, and to document parental decisions following counseling for fetal surgery. DESIGN: Single center retrospective study on patients with presumed iCDH either referred for assessment and counseling or referred for fetal surgery. Discordant findings were defined as either a >10% difference in lung size, discordant liver position or associated anomalies. RESULTS: Outcomes from 129 consecutive assessments over 24 months were analyzed. Among fetal surgery referrals, 2% did not have CDH, and 10% had undiagnosed associated anomalies. Liver position was discordant in 7%. Thirty-three per cent had discordant lung size. Ninety-four per cent of patients eligible for surgery underwent FETO. In patients referred because of suspicion of CDH, associated anomalies were found in 14%. Fetal liver and lung assessments were discordant in 50% resp. 38%. Of those patients eligible for FETO, 26% requested termination. For three patients, the postnatal course was marked by a genetic or syndromic additional diagnosis. CONCLUSION: Discordances between initial assessment before referral and evaluation in our institution were frequent, some of them clinically relevant.
OBJECTIVE: Fetoscopic endoluminal tracheal occlusion (FETO) may improve outcome of severe isolated congenital diaphragmatic hernia (iCDH). We aimed to identify any discrepancy between initial assessment at the referring hospital and the evaluation at the fetal surgery center, and to document parental decisions following counseling for fetal surgery. DESIGN: Single center retrospective study on patients with presumed iCDH either referred for assessment and counseling or referred for fetal surgery. Discordant findings were defined as either a >10% difference in lung size, discordant liver position or associated anomalies. RESULTS: Outcomes from 129 consecutive assessments over 24 months were analyzed. Among fetal surgery referrals, 2% did not have CDH, and 10% had undiagnosed associated anomalies. Liver position was discordant in 7%. Thirty-three per cent had discordant lung size. Ninety-four per cent of patients eligible for surgery underwent FETO. In patients referred because of suspicion of CDH, associated anomalies were found in 14%. Fetal liver and lung assessments were discordant in 50% resp. 38%. Of those patients eligible for FETO, 26% requested termination. For three patients, the postnatal course was marked by a genetic or syndromic additional diagnosis. CONCLUSION: Discordances between initial assessment before referral and evaluation in our institution were frequent, some of them clinically relevant.
Authors: Lennart Van der Veeken; Francesca Maria Russo; Luc De Catte; Eduard Gratacos; Alexandra Benachi; Yves Ville; Kypros Nicolaides; Christoph Berg; Glenn Gardener; Nicola Persico; Pietro Bagolan; Greg Ryan; Michael A Belfort; Jan Deprest Journal: Gynecol Surg Date: 2018-05-08